Title: posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes.The purpose of this article was to evaluate the results of all-inside suture repair of longitudinal tears of the lm posterior horn with a suture hook using a posterolateral portal as described by ahn et al.In athletic patients.Between december 2014 and january 2018, a total of 24 patients had an arthroscopic repair of a longitudinal tear involving the posterior horn of the lm.Athletes with tears associated with anterior cruciate ligament (acl) reconstruction were included.All the 24 patients were involved in competitive sports.Meniscal tears were found in 14 right and 10 left knees.The mean follow-up was 25.2 ± 10 months.The mean age at surgery was 24.4 ± 8.8 years.The time elapsed between the injury event and surgery was 86.4 ± 106 days (min 2¿max 539).Based on the intraoperative assessment, 19 of the lesions were bucket handle tears, 1 was an unstable discoid meniscus detached from its posterior menisco-synovial junction, and 4 were tears of the posterior horn of the lateral meniscus (phlm) detached at the menisco-synovial junction.In more than half of the cases (13), the posterior horn tear also affected the mid-body (ph¿mb); 8 were limited to the posterior horn (ph) and 3 affected the entire meniscus (ph¿mb¿ah).Using the trans-notch view, the posterolateral tear of the lm was then debrided with a shaver introduced through the posterolateral portal.A 25° hook (quick pass lasso low profile; arthrex, naples, fl) loaded with a size 0 pds absorbable suture (ethicon, inc., somerville, nj) was introduced through the posterolateral portal.The suture hook was manipulated by hand, so that the sharp tip penetrated the peripheral wall of the lm from top to bottom.Next, the suture hook was passed through the central (inner portion) of the torn lm from bottom to top.The free ends of the suture were grasped through the posterolateral portal and a sliding knot was tied and positioned onto the most posterior part of the meniscus with the help of a knot pusher.This maneuver was repeated as required depending on the length of the tear¿one stitch was placed every 5 mm for tears limited to the posterior segment.When the tear extended towards the mid-body or up to the anterior horn, additional suture repair was performed using a meniscal suture anchor device through the anterior portal or using an outside-in technique.To finish the procedure, the repair¿s stability was tested with a probe.Of the initial 24 patients, 4 (16.6%) had a failed repair and were re-operated by the same technique.Two more needed a new surgery: the first underwent arthroscopic arthrolysis for stiffness 4 months after the first surgery which included an acl reconstruction and the second underwent arthroscopic exploration for a suspected re-tear after almost 2 years.In both cases, the meniscus had healed.For 20 patients, we used an all-inside meniscal anchor technique for the mid-body area and/or the anterior horn, and in 8 cases, an outside-in technique.None of the patients who suffered a failed repair had an outside-in procedure.The median tegner score before the injury was 7 (min 4¿max 10) and all patients had regained the same level at the last follow-up.The objective and subjective ikdc scores were significantly improved at the last follow-up, and there was no difference between successful and failed repairs.The subjective ikdc rating increased from 41.8 (12.2) to 94.5 (9.1).When we analyzed the failures, all of them occur in highly active athletes (preoperative tegner score 9); these patients were professional soccer players or from a soccer training center.All the lesions were isolated bucket handle tears without associated acl tear, all these patients were treated with an all-inside meniscal suture anchor for the midbody and/or the anterior portion of their lm (the outside-in repair technique was not used in the failures cases).The mean time elapsed between the surgery and failure was 9.3 months (± 7) and three of the revisions were for exactly the same lesion as initially.All of them underwent a successful second repair and were able to return to play at the same level than before the injury.Postoperative complications in included n=4 failed repair.In conclusion, despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the lm.The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.
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Product complaint # (b)(4).If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Attempts are being made to obtain the following information.To date no response has been provided.If further details are received at a later date a supplemental medwatch will be sent.Does the surgeon believe that any of the ethicon products involved caused and/or contributed to the post-operative complications described in the article? does the surgeon believe there was any deficiency with any of the ethicon products used in this procedure? if so, please provide details.Were the cases discussed in this article previously reported to ethicon? if yes, please provide a complaint reference number.Patient demographics? this report is related to a journal article; therefore, no product will be returned for analysis and the batch history records cannot be reviewed as the lot number has not been provided.(b)(4).The single complaint was reported with multiple events.There are no additional details regarding the additional events.Citation: archives of orthopaedic and trauma surgery (2021) 141:1101¿1108 https://doi.Org/10.1007/s00402-020-03504-5.
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